Cruz Vítor Tedim, Pais Joana, Teixeira Alexandre, Nunes Belina
Serviço de Neurologia, Hospital S. Sebastião, Santa Maria da Feira.
Acta Med Port. 2004 Nov-Dec;17(6):435-44. Epub 2005 Jan 18.
Early recognition of Alzheimer's disease (AD) symptoms is crucial to the integration of patient and caregiver in the healthcare system. Family perception of initial cognitive and behavioural symptoms is decisive and has impact on quality of life of both patient and family.
To analyse caregiver's perception of initial AD symptoms and characterize the degree of cognitive decline that determines disease recognition.
A semi-structured interview was performed including questions about: i) socio-economic characterization of patient and caregiver; ii) disease natural history; iii) DA first symptoms. The interview was applied by phone to a sample of caregivers of patients from two memory clinics.
Were included 41 patients (22 M;19 F) with age at onset of 69 years (51-81) and a mean of 14.6 months (2-43) since diagnosis. School level: patients = 3.2 +/- 2.2 and caregivers = 5.37 +/- 3.2 years; leisure activities score: patients = 2.6 +/- 1.9 and caregivers = 2.9 +/- 2. Patients were recognized with involvement of 4-6 cognitive areas in 58.5%; only 12.2% had one cognitive area involved. Women cared by their husbands had less cognitive areas involved at initial perception than men cared by their wives (2.7 +/- 1.5 vs 4 +/- 2.5). Time interval since family perception until reporting to the general practitioner (GP) was 4.16 +/- 5.7 months and to neurological observation 27.7 +/- 13.9. No correlation was found between these intervals and school level or leisure activities.
Families have difficulties in the detection of initial dementia symptoms and in adequately transmitting them to GP. The pair of patient and caregiver seemed determinant in dementia recognition: female patients were recognized with less cognitive areas involved, probably in relation with their greater enrollment in household activities. The characterization of the process of perception in dementia is crucial for definition of adequate strategies of detection and intervention in AD.
早期识别阿尔茨海默病（AD）症状对于患者及其照料者融入医疗保健系统至关重要。家庭对初始认知和行为症状的认知具有决定性作用，并会影响患者和家庭的生活质量。
分析照料者对AD初始症状的认知，并确定决定疾病被识别的认知衰退程度。
进行了一次半结构化访谈，包括以下问题：i）患者和照料者的社会经济特征；ii）疾病自然史；iii）AD首发症状。通过电话对来自两家记忆诊所的患者照料者样本进行了访谈。
纳入41例患者（22例男性；19例女性），发病年龄为69岁（51 - 81岁），自诊断以来平均病程为14.6个月（2 - 43个月）。受教育程度：患者为3.2±2.2年且照料者为5.37±3.2年；休闲活动得分：患者为2.6±1.9分且照料者为2.9±2分。58.5%的患者累及4 - 6个认知领域；仅12.2%的患者累及1个认知领域。由丈夫照料的女性患者在初始认知时累及的认知领域比由妻子照料的男性患者少（2.7±1.5 vs 4±2.5）。从家庭意识到向全科医生（GP）报告的时间间隔为4.16±5.7个月，向神经科医生就诊的时间间隔为27.7±13.9个月。这些时间间隔与受教育程度或休闲活动之间未发现相关性。
家庭在发现痴呆初始症状并将其充分传达给全科医生方面存在困难。患者与照料者这一对组合似乎在痴呆识别中起决定性作用：女性患者被识别出累及的认知领域较少，这可能与其更多地参与家务活动有关。痴呆认知过程的特征描述对于确定AD的充分检测和干预策略至关重要。
